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---- ---- ----- - ------------ <br /> APPLICATION FOR SANITATION PERMIT Permit No. . ........... <br /> (Complete in Duplicate) <br /> This Permit Ex fres 1 Year From Date Issued <br /> Date Issued ./-Q:--,�,U-:-�� <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct an <br /> This application is made in compliance with County Ordinance No. 549. d install the work herein described. <br /> JOB ADDRESS AND LOCATION-__-- V le <br /> -...e-A -------- <br /> Owner's Name <br /> --- ------------ <br /> Address---- .. <br /> ------- one... : / <br /> Contractor's Name------ '��-� � C. '�k <br /> ----- <br /> - - ---- ....... Phone. <br /> Installation will serve: Residencep <br /> ❑ A artment House;® Commercial ❑ Trailer Court ❑ Motel <br /> Number of living units: _'�-- Number of bedrooms __P_ Number of baths - -_ Lot size /Gf _❑ Other ❑ <br /> Water Supply: Public system - '� ted.0._..._._._..•-"--------------"_"--__ <br /> PP y' Y ❑ Community system ❑ Private ® Depth to Water Table ---__ ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ ; •Gravel ❑ Sandy Loam ❑ Clay Loam (�, Clay ❑ Adobe ❑ Hardpan ❑ <br /> Previous Application Made: (If yes date._..-"- ....."."""-) No � New Construction: Yes � No ❑ FHA/VA: Yes ❑ No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank­-,. Distance from nearest well---&0----Distance from foundation....?a. -------Material__.C," <br /> No. of compartments_.__....L- - -------- <br /> Size - Liquid depth. - - -------- Ca acit . <br /> Disposal Field: Distance from nearest well.j".j0---/.---Distance from foundation-AP!---------Distance to nearest lot <br /> Number of lines.__.__.._ .._ -."_ __-."_--Length of each line.___imp/- .. <br /> nn ...Width of french------av-1 ------ -- ------ <br /> Type of filter material.e�._'./s c._iC'_-Depth of filter material_.__ <br /> --j----./--Total length-_,0O_h`-/,44.f 4.... <br /> Seepage Pit: Distance to nearest well.._,O-U-.� Distance from foundation__/`-�----_-.Distance to nearest lot line_/CL._t"-".- <br /> p 4-.__. ._Lining material-_:___._ _- 3 k.'.'® Number of its."_..-- - -- "--.Size: Diameter.__... -"_""-.Depth- ----- <br /> Cesspool: Distance from nearest well.______________Distance from foundation-.. .._ _...__.._.Lining material.___..__.___.___._._..._....._.. <br /> ❑ Size: Diameter. "- ." -""-- _" <br /> - - --- Depth------------ -------- -- -- ---- -._Liquid Capacity- - ---------------- -•---gals. <br /> Privy: Distance from nearest well_--------------- --------------------" --Distance from nearest building--------------- ------------------------- <br /> ❑ Distance to nearest lot line.. <br /> Remodeling and/or repairing (describe):_------------------------------- <br /> ------------••---- •----•-------- ------------ -•------••-- ---------------- -----_-----_-- --------------- ------------ ------------ -- <br /> - ------ -----_ ----------•---------------------------------- -•------------•--------•----------------------------- -------------------------------------------------- -------------------- <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordina State laws, and rules and regulatiops of the San Joaquin Local Health District. <br /> (Signed)----- <br /> �Z. ... ----- ---- ------------ ------------------------------ --------- ------(Owner and/or Contractor) <br /> By-------------------------------------------------------------------------------------- •------ --(Title) --------------- ------ -- ---------- .. <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED DATE../_.�J..-..���A. <br /> REVIEWEDBY--------------------------------------------- ------------------------------------------- ------------------------- DATE <br /> BUILDING PERMIT ISSUED----- ------- <br /> Alterations <br /> -----Alterations and/or recommendations:___.___..._....___._........ <br /> �.�� . - 3 d7----- ------- <br /> a------ ------------ -------- --------- ...... ......... <br /> r <br /> FINAL INSPECTION BY:.V ...�r.....`..R� .... ......... Date..(..I——...�... G <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton, California - Lodi,California Manteca,Califon - Tracy,California <br />